What is the prevalence of postcholecystectomy syndrome and what are risk factors?

Updated: Nov 28, 2018
  • Author: Steen W Jensen, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

During the late 1990s, approximately 500,000-600,000 cholecystectomies were performed each year in the United States; most of them were laparoscopic. With at least 10% of patients developing PCS, approximately 50,000 or more cases of PCS occur each year. Study-to-study variability is great. PCS is reported to have been found in 5-30% of patients, with 10-15% being the most reasonable range.

McHardy found that 7.5% of patients with PCS required hospitalization. [6] The international incidence of PCS is almost identical to that in the United States.

Peterli found that 65% of patients had no symptoms, 28% had mild symptoms, 5% had moderate symptoms, and 2% had severe symptoms. [7] Peterli also found that PCS was caused by functional disorders in 26% of patients, peptic disease in 4%, wound pain in 2.4%, stones in 1%, subhepatic fluid in 0.8%, and incisional hernia in 0.4%.

Schoenemann found that functional disorders were the most common cause of PCS. [8] Russello found 30% of patients with postcholecystectomy symptoms, 13% with PCS, and 10% with the same preoperative symptoms. [9] Anand had 18% of patients with symptoms (24 mild, 7 severe). [10] Freud found that 62% of patients had less severe symptoms than preoperatively, 31% had the same symptoms, and 7% had more severe symptoms. [11]

In the author’s experience, a 14% risk of PCS exists among all patients, and the risk of PCS has not been associated with any preoperative finding.

It should be noted that about 50% of patients with a preoperative psychiatric disorder have an organic cause of PCS, whereas only 23% of patients without a psychiatric disorder have an organic cause.

Numerous researchers have attempted to develop preoperative risk stratification. No full consensus has been reached, but many would agree that a proper preoperative workup and skilled surgery should include complete evaluation of the extrahepatic biliary tree. Some risk stratification summaries follow:

  • An urgent operation puts patients at a higher risk for developing PCS
  • If the procedure is performed for stones, 10-25% of patients develop PCS; if no stones are present, 29% of patients develop PCS
  • If the duration of symptoms before surgery is less than 1 year, 15.4% of patients develop PCS; if preoperative symptom duration is 1-5 years, 21% develop PCS; if preoperative symptom duration is 6-10 years, 31% develop PCS; and if preoperative symptom duration is more than 10 years, 34% develop PCS
  • If a choledochotomy is performed, 23% of patients develop PCS; if choledochotomy is not performed, 19% develop PCS

Some researchers have found the incidence of PCS to be the same, regardless of typical or atypical preoperative symptoms. Previous surgery, bile spill, and stone spill did not make a difference in the incidence of PCS.


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